Acute care beta-lactam allergy pathways: approaches and outcomes

Abstract

Acute care beta-lactam allergy pathways are coordinated allergy assessment programs for hospitalized patients as an antibiotic stewardship tool, which can be based on the allergy history alone, or use the allergy history to guide procedures such as drug challenges and/or penicillin skin testing. Pathways commonly targeted patients likely to benefit from acute care penicillin allergy evaluations: patients on specific broadspectrum antibiotics, referred from Infectious Diseases specialists, and/or patients with specific infections or bacterial culture results. Acute care beta-lactam pathways were safe and report decreased alternative antibiotic use and increased beta-lactam antibiotic use. Instructions Credit can now be obtained, free for a limited time, by reading the review article and completing all activity components. Please note the instructions listed below: Review the target audience, learning objectives and all disclosures. Complete the pre-test. Read the article and reflect on all content as to how it may be applicable to your practice. Complete the post-test/evaluation and claim credit earned. At this time, physicians will have earned up to 1.0 AMA PRA Category 1 Credit TM. Minimum passing score on the post-test is 70%. Overall Purpose Participants will be able to demonstrate increased knowledge of the clinical treatment of allergy/asthma/immunology and how new information can be applied to their own practices. Learning Objectives At the conclusion of this activity, participants should be able to: Identify the benefits of inpatient beta-lactam allergy assessments. Describe different approaches to beta-lactam allergy pathways including the methods used to identify patients.

Role of clinical history in beta-lactam hypersensitivity

“…pathways have emerged as an inpatient standard of care and integral part of antibiotic stewardship programs [35].…”

“…For inpatients, drug allergy pathways have proven revolutionary by simply bringing beta-lactam allergy evaluation to the hospital bedside – a place where beta-lactams may be critically needed, yet previously unreached. Whether performing a DOC to penicillin or amoxicillin (thereby ‘de-labeling’ the penicillin allergy) or alternatively, performing a challenge to the indicated therapeutic beta-lactam (often a cephalosporin, which facilitates timely, appropriate antibiotic treatment for acutely infected patients), drug allergy pathways have emerged as an inpatient standard of care and integral part of antibiotic stewardship programs [35].…”

Effectiveness and Feasibility of Pharmacist-Driven Penicillin Allergy De-Labeling Pilot Program without Skin Testing or Oral Challenges

“…Many studies have developed algorithms or questionnaires to aid in the process of de-labeling patients with PCN allergies [ 9 , 10 ]. Several algorithms used by different health systems across the US have been published and many recommend skin testing, direct oral challenges, and/or contain explicit recommendations for alternative cephalosporins [ 10 ].…”

“…Many studies have developed algorithms or questionnaires to aid in the process of de-labeling patients with PCN allergies [ 9 , 10 ]. Several algorithms used by different health systems across the US have been published and many recommend skin testing, direct oral challenges, and/or contain explicit recommendations for alternative cephalosporins [ 10 ]. Literature supports the use of penicillin antibiotics if the history suggests a non-immune mediated intolerance [ 3 ] or if the allergic reaction is considered low-risk [ 1 ].…”

Antibiotic Use in Patients With β-Lactam Allergies and Pneumonia: Impact of an Antibiotic Side Chain–Based Cross-Reactivity Chart Combined With Enhanced Allergy Assessment

“…Strategies to increase β-lactam use in patients with β-lactam allergies include pathways that incorporate patient assessment through historical review, direct oral challenges, penicillin skin testing (PST), and specialist evaluation [ 2 , 22 , 23 ]. Several strategies may present challenges for institutions limited by resources, legal authority, or the time-limiting nature of the intervention in relation to the volume of patients with pneumonia [ 2 , 24 ].…”